Optimal Tests to Minimise Bleeding and Ischaemic Complications in Patients on Extracorporeal Membrane Oxygenation
| Autor: | Diana A. Gorog, Rahim Kanji, Susanna Price, Christophe Vandenbriele, Deepa R. J. Arachchillage |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Heparin business.industry medicine.medical_treatment MEDLINE Anticoagulants Hemorrhage Thrombosis Hematology 030204 cardiovascular system & hematology Review article 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Extracorporeal membrane oxygenation medicine Humans Partial Thromboplastin Time In patient 030212 general & internal medicine Intensive care medicine business |
| Zdroj: | Thrombosis and Haemostasis. 122:480-491 |
| ISSN: | 2567-689X 0340-6245 |
| DOI: | 10.1055/a-1508-8230 |
| Popis: | Patients supported with extracorporeal membrane oxygenation (ECMO) experience a very high frequency of bleeding and ischaemic complications, including stroke and systemic embolism. These patients require systemic anticoagulation, mainly with unfractionated heparin (UFH) to prevent clotting of the circuit and reduce the risk of arterial or venous thrombosis. Monitoring of UFH can be very challenging. While most centres routinely monitor the activated clotting time and activated partial thromboplastin time (aPTT) to assess UFH, measurement of anti-factor Xa (anti-Xa) level best correlates with heparin dose, and appears to be predictive of circuit thrombosis, although aPTT may be a better predictor of bleeding. Although monitoring of prothrombin time, platelet count and fibrinogen is routinely undertaken to assess haemostasis, there is no clear guidance available regarding the optimal test.Additional tests, including antithrombin level and thromboelastography, can be used for risk stratification of patients to try and predict the risks of thrombosis and bleeding. Each has their specific role, strengths and limitations. Increased thrombin generation may have a role in predicting thrombosis. Acquired von Willebrand syndrome is frequent with ECMO, contributing to bleeding risk and can be detected by assessing the von Willebrand factor activity-to-antigen ratio, while the platelet function analyser can be used in urgent situations to detect this, with a high negative predictive value. Tests of platelet aggregation can aid in the prediction of bleeding.To personalise management, a selection of complementary tests to collectively assess heparin-effect, coagulation, platelet function and platelet aggregation is proposed, to optimise clinical outcomes in these high-risk patients. ispartof: THROMBOSIS AND HAEMOSTASIS vol:122 issue:04 pages:480-491 ispartof: location:Germany status: published |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|